Nurse have to know So much and partly play the role of doctor and pharmacist - eek!

[Nunurse0821]

I feel like we have to play the role of pharmacist somewhat (knowing side effects and contraindications) and doctor somewhat (if they prescribed the correct drug, route or dose and if they considered the allergies ) and we are responsible for knowing if they have made a mistake. When I become a new nurse I feel like this gives me so much to be responsible for and it scares and overwhelms thinking that I might not catch a mistake they made. I just feel like this is a lot to put on nurses, especially new nurses. Can anybody make me feel less stressed out or put things in a different perspective? I feel like we have to know a little bit about everything and that's kinda overwhelming to me. Thanks! 

[amgRN, ASN, BSN, RN]

You are right about this being a lot to deal with as a new nurse and it is stressful.  If you have a pharmacist checking orders where you work, that should make you feel better.  They can make mistakes too, but they are another set of eyes reviewing orders.  Most floors tend to have patients taking the same groups medications, so you will become more familiar with the common meds in your workplace as you gain more experience. 

Make sure you have a good drug app on your phone and be familiar with it.  Before you give any medications you are not familiar with, check your app or a drug handbook.  Taking a few seconds to look up a medication and verify the expected dose and route of admission will help you remember the meds and will ensure you are administering the medication safely. 

Never feel embarrassed to look up meds before you give them.  You are responsible for the way you practice as a nurse and for your new license!  Use any resources you need to be safe.  You can even buy a very small flip notebook to keep med notes or make your own badge buddies with medications you come across if you want to have your own mini-resource.  

It will get easier though!  Don't be discouraged.  Also, never hesitate to have another experience nurse double check something with you if you are unsure.  We have all be in your shoes!

amg

[Nunurse0821]

7 minutes ago, amgRN said:

You are right about this being a lot to deal with as a new nurse and it is stressful.  If you have a pharmacist checking orders where you work, that should make you feel better.  They can make mistakes too, but they are another set of eyes reviewing orders.  Most floors tend to have patients taking the same groups medications, so you will become more familiar with the common meds in your workplace as you gain more experience. 

Make sure you have a good drug app on your phone and be familiar with it.  Before you give any medications you are not familiar with, check your app or a drug handbook.  Taking a few seconds to look up a medication and verify the expected dose and route of admission will help you remember the meds and will ensure you are administering the medication safely. 

Never feel embarrassed to look up meds before you give them.  You are responsible for the way you practice as a nurse and for your new license!  Use any resources you need to be safe.  You can even buy a very small flip notebook to keep med notes or make your own badge buddies with medications you come across if you want to have your own mini-resource.  

It will get easier though!  Don't be discouraged.  Also, never hesitate to have another experience nurse double check something with you if you are unsure.  We have all be in your shoes!

amg

Thank you so much! I wish you could be my preceptor ? I just started nursing school last month. I'm in an accelerated BSN program that is 16 months long. Even some of the questions I'm getting for my homework are asking me to decide what medication to give a patient. For example: After reviewing the chart of a patient with heart failure, the nurse should be prepared to administered what diuretic? and I'm thinking to myself, I have to know that too!? Isn't that the doctor's job?? It's just all getting very overwhelming with the amount of information they expect us to know and it makes me feel like I won't be able to get very good at anything because there is just so much to learn and that they want us to know. That is a great idea though about using an app and our teacher encourages us to use Lexicomp. I just feel like with the hectic environment of being a floor nurse if I have an emergent situation what if I don't have the time? I guess I'm thinking worst case scenario. I'm just worried I'll mess up because I wasn't able to learn it all. I guess that's what the NCLEX is for! It will be the judge of that! haha

[amgRN, ASN, BSN, RN]

You are sweet.  I love nursing students. Congratulations on starting nursing school!  And don't worry.  It will all start coming together.  

Try these couple of things in your pharmacology class.  When you learn your drug classes, spend a bit of time figuring out the action of that drug class and what it is doing in the body.  You may have to read it a few time and think about it or look up more information online, but figure it out.  Taking the time to understand the action of the drug class will greatly improve your understanding and also cut down on your study time because understanding is much faster and easier than memorizing a pile of words that don't make sense.  

After you understand the action of a drug class, fill out a concept map for that class.  As you are filling it out, be thinking about that action and see if you can connect those actions to the side effects.  Often the side effects are just an "over" effect of the drug.  Using your example, if diuretics cause the body to increase urination, most of the common side effects are related to the body losing too much fluid.  If we give a patient a medication to lower their blood pressure, most of those common side effects are related to the blood pressure being too low.  Look for those connections.  

If you are in an ABSN, you probably are learning anywhere from 20-25 drugs per exam.  Work on 2 -4 drug classes each day and spend a bit of time reviewing the ones you did the days before.  

As for the rest, don't get ahead of yourself.  You will be fine by the time you are passing meds on your own.  

Best of luck this quarter/semester!  

amg

[Nunurse0821]

Thank you SO much! ? Do you mean something like this? Attached.  I was trying to Google concept maps for drug classes and this one seemed pretty good

We actually have to know just under 40 for our first exam if I count each electrolyte ? She wants us to know mechanism of action, primary actions, important adverse effects, and nursing interventions. Should I make a concept map for each one do you think? That's what I was thinking of doing. Thanks for all your advice! I really appreciate it ?

Acid-Base Agent: sodium bicarbonate

Electrolytes: sodium, potassium, calcium, magnesium

Urinary Tract Anti-infective: trimethoprim/sulfamethoxazole

Urinary Tract Antiseptics: nitrofurantoin or methenamine

Urinary Tract Antispasmodic: oxybutynin

Urinary Tract Analgesic: phenazopyridine

Muscarinic Agonist: bethanechol

Alpha-Adrenergic Blocker: tamsulosin

Testosterone Blocker: finasteride

Loop Diuretics: furosemide

Thiazide Diuretics: hydrochlorothiazide

Potassium-Sparing Diuretics: spironolactone

Osmotic Diuretics: mannitol

Histamine-2 Blockers: ranitidine recalled cimetidine

Proton Pump Inhibitors: omeprazole

Antacids: aluminum hydroxide, magnesium hydroxide, calcium carbonate, sodium bicarbonate

GI Protectant: sucralfate

Prostaglandin: misoprostol

Digestive Enzymes: pancrelipase

Laxatives: 

magnesium hydroxide / milk of magnesia

psyllium

bisacodyl

docusate sodium

GI Stimulant: metoclopramide

Antidiarrheal: loperamide or diphenoxylate HCL w/atropine

Antiflatulant: simethicone

Antiemetics:

prochlorperazine

ondansetron

scopolamine

lorazepam

Glucocorticoid: dexamethasone

dronabinol

Anti-inflammatory Sulfonamide: sulfasalazine

Lipid-soluble Vitamin: vitamin A

Water-soluble Vitamin: folic acid and cyanocobalamin

Lipase Inhibitor: orlistat

[amgRN, ASN, BSN, RN]

That's great! Really the concept maps can be whatever makes logical sense to you. There are a lot on etsy too, strangely enough.  That is a lot of drugs so really truly work on them every day.  Some people make up silly stories or word associations to help them remember drug facts. If you are a visual/auditory learner, Picmonic is a great resource and a lot of students really like it for Pharm.  

The other piece of advice I would add it to keep your concept maps very, very brief.  A very simple explanation of the drug, how it works, the most common side effects, and the nursing actions that are most common and those that have big safety implications. 

Don't forget to put everything in your own words.  Also, if you have related or similar drugs, such as the diuretics, be sure to look for the things that make each one different from the others.  That will help you decide correct answers when you take your test.  

[JKL33]

On 9/25/2021 at 10:26 PM, Nunurse0821 said:

Even some of the questions I'm getting for my homework are asking me to decide what medication to give a patient. For example: After reviewing the chart of a patient with heart failure, the nurse should be prepared to administered what diuretic?

Hello and welcome.

There is a nuance here for you to understand: Notice the wording of the homework question. It is not asking you to decide, it is asking you to anticipate something, to be prepared/ready to administer something.

This is so that when you are caring for a patient with heart failure you have some idea what is going on with that pathophysiology and some idea what types of medications would be expected to improve the condition. Then you can be prepared and ready to safely administer that therapy after it is ordered and aren't out in left field having no idea whether a beta blocker or an antibiotic or a loop diuretic makes sense for your patient.

I promise I am not splitting hairs when I say that there is a significant legal and licensure difference between "deciding" and "anticipating"/being prepared. Nursing school almost always uses language along the lines of "what should the nurse anticipate?" for a reason.

Does that make sense?

Nurses basically are expected to know if something is significantly off-kilter with an order. Again, that is very different than being expected to be able to legally select an appropriate therapy.

With regard to phone apps/self-sourced drug references: I do not recommend these unless they are approved by the parent institution (for now your school, later your employer). Your school has a drug reference that they have required you to have available and that is what you should use to look up medications and to prepare for medication administration. When you are employed as an RN, you will use the reference approved by your employer. Many EMRs now have drug reference information integrated into the EMR and often directly accessible from the medication administration interface.

If you study appropriately you will have the information needed to care for patients safely and the skills to get answers when questions arise.

Best of luck to you! ?

[amgRN, ASN, BSN, RN]

9 hours ago, JKL33 said:

With regard to phone apps/self-sourced drug references: I do not recommend these unless they are approved by the parent institution (for now your school, later your employer).

I think your comment might be referring to my suggestion to use Picmonic.  Picmonic is a study resource for students (PA students, pharmacology students, NPs, nurses, etc.).  It is a very effective learning tool for students. that are trying to memorize large numbers of medications in a short amount of time.  It is in no way a substitute for appropriate drug reference books.  ?

[JKL33]

26 minutes ago, amgRN said:

I think your comment might be referring to my suggestion to use Picmonic.  Picmonic is a study resource for students (PA students, pharmacology students, NPs, nurses, etc.).  It is a very effective learning tool for students. that are trying to memorize large numbers of medications in a short amount of time.  It is in no way a substitute for appropriate drug reference books.  ?

It wasn't in response to that.

I'm aware of Picmonic and agree that many people find it useful. ?

It was meant as general practice advice. Hospitals I have worked in have had policies that note their approved drug references; the implication being that those not mentioned are not approved. When my last place was finished integrating their approved reference into the EMR/eMAR they subsequently decided not to keep updated hard copies of the typical nursing drug reference books around. It probably isn't the best idea for employed nurses to pick their own resource to use while at work. if they choose an app that isn't updated with enough frequency, for example, they would not be supported in wrong decisions based off that incorrect or incomplete or outdated info.

For students it may be a little different but I can think of reasons it might be best to use the school's required drug reference as a basis for graded work, Care Plans, etc. 

[Jack Hazz, BSN, RN]

Well, welcome to my world, where I play a part-time job of being an MD, pharmacist, social worker, hospice aid and chaplain. Plus when patients and family are frustrated, grieving and emotional, you also become a sponge to absorb it all, their anger, their fear, their anxiety...And to top it all off, despite signing on with hospice, you should be a miracle worker and treat their love one and make them well. And that is because their agitation or pain or sob or anxiety got better because you administered the comfort meds they oh, so declined to use for the longest time because it will kill the patient....oh well.

[OUxPhys, BSN, RN]

Yep. Welcome to the party. Nursing: The only profession where you are responsible for people's mistakes who went to school longer than you and make significantly more money than you.